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P�r�MIT APPLICATIG�� ���'��9 � <br /> CITY OF EVERETT PERMIT SERVICES ������%3 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � U �'��� �� <br /> ���(,���,;,��6 425-257-8810— FAX 425-257-8857—www.evereflwa.org eU� OS'�l Z <br /> �� ����� <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT AC EPTE <br /> SITE ADDRESS PARCEL TAX I.D.N PER�IT/ <br /> �,� ��,, vu 3�z 9 � iov _ � -Sl��o <br /> LEGA LOiNO. BLOCK TRACT <br /> DES0. I �� � -UQ <br /> OWNER ADDRESS CITY2Ip PHONE <br /> u+�dV�tw Con}rc.c�,rc �cc �a 3ox auy� �uvc�-h 9bz13 '/.�S•Sw - 7.ay7 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE � , <br /> CONTRACTORso�.� V�tu <<���'�mJ «< ADDRESS CITY2IP PHONE <br /> t�u 3oK �43 Euu�r+Sdzi; vzS H7u-7z�/7 <br /> CONTR.LICENSE M 5C7 L��d c-�.9 5 I Kq <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric ,�Gas Olher ��Kd/ UUG <br /> Re5 derce — — <br /> WORKDESCRIPTION �,��+r�cf Ne� Dc:PieX .�/��j� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilol WC—alr handling units <br /> � Balhtub Forced alr systems <br /> Lavalory(wash basin) � Gas piping <br /> � Showor � Walerheater <br /> � Kitchen sink 8 disposat Gas fireplace <br /> � Dishwasher Gas range <br /> � Clothes washor Clothes dryer <br /> _ Laundry tray Range hoad <br /> Sink(sorviceNadmoplelc.) Exhausl(an r.�. ��� <br /> Back9ow prevonter Heat pump <br /> Urinal UNl heater <br /> Drinking Fountain _ Bolier <br /> Floor drain Re(Ageralion <br /> Greaso trap Woodslove <br /> Roof drains Olher <br /> Othor <br /> CITY OF FVERETT LOCAL SALES TNC CODE 19 J105 <br /> I hcroby ceritify that I have road and examinod lhis applicalion and know the same to be irue and correct. All provisfons of laws and <br /> ordinaces governing this lype of work o+ill be complied with whether specified hereln or not.The granling of a pertnit does nol presume <br /> to give aulhority to violale or cancel e provision of any olhor state or local law regulating consfrucUon or lhe perfortnance of <br /> construction. Thal I am aulh y lhe owner of lhis property lo perlortn lhe work for which applicatlan Is made end I comply with ihe <br /> Stale Conlr r RCW a WAC. <br /> �- B -Os `/ <br /> Sign ura of wnor/ ontractor/Aut orized gent ate L <br /> R�' /72RS <br />